Hanson Jacob T, Sabal Luke T, Jean James N, Jonason Alec, Johnson Reid, Lisko Thomas, Moua Yeng, McGovern Robert A
Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA.
University of Minnesota Department of Neurosurgery, Minneapolis, MN, USA.
World Neurosurg X. 2024 Feb 25;22:100299. doi: 10.1016/j.wnsx.2024.100299. eCollection 2024 Apr.
Patients with normal pressure hydrocephalus (NPH) and Parkinson's Disease (PD) can clinically appear quite similar at baseline evaluation. We sought to investigate the use of kinematic assessment of postural instability (PI) using inertial measurement units (IMUs) as a mechanism of differentiation between the two disease processes.
20 patients with NPH, 55 patients with PD, and 56 age-matched, healthy controls underwent quantitative pull test examinations while wearing IMUs at baseline. Center of mass and foot position data were used to compare velocity and acceleration profiles, pull test step length, and reaction times between groups and as a function of Unified Parkinson's disease Rating Scale Pull Test (UPDRS) score.
Overall, the reactive postural response of NPH patients was characterized by slower reaction times and smaller steps compared to both PD patients and healthy controls. However, when patients were grouped by UPDRS scores, no reliable objective difference between groups was detected.
At their initial evaluation, very few NPH patients demonstrate "normal" or "mild" PI as they appear to be older upon presentation compared to PD patients. As a result, kinematic assessment utilizing IMUs may not be helpful for differentiating between NPH and PD as a function of UPDRS score, but rather as a more fine-tuned method to define disease progression. We emphasize the need for further evaluation of incorporating objective kinematic data collection as a way to evaluate PI and improve patient outcomes.
正常压力脑积水（NPH）患者和帕金森病（PD）患者在基线评估时临床表现可能非常相似。我们试图研究使用惯性测量单元（IMU）对姿势不稳（PI）进行运动学评估，以此作为区分这两种疾病过程的一种方法。
20例NPH患者、55例PD患者以及56例年龄匹配的健康对照者在基线时佩戴IMU进行定量拉拽试验检查。使用质心和足部位置数据来比较各组之间的速度和加速度曲线、拉拽试验步长以及反应时间，并将其作为统一帕金森病评定量表拉拽试验（UPDRS）评分的函数。
总体而言，与PD患者和健康对照者相比，NPH患者的反应性姿势反应表现为反应时间较慢且步长较小。然而，当根据UPDRS评分对患者进行分组时，未检测到组间有可靠的客观差异。
在初次评估时，很少有NPH患者表现出“正常”或“轻度”的PI，因为与PD患者相比，他们就诊时年龄似乎更大。因此，利用IMU进行运动学评估可能无助于根据UPDRS评分区分NPH和PD，而更适合作为一种更精细的方法来定义疾病进展。我们强调需要进一步评估纳入客观运动学数据收集，以此作为评估PI和改善患者预后的一种方式。
